December 24

Why didn't I think of that?

11  comments

An article appeared yesterday in the online version of the British Medical Journal reporting that regular didgeridoo playing reduces snoring and daytime sleepiness, both symptoms of sleep apnea.
I’ve never tried playing a didgeridoo nor have I ever recommended it to any of my many patients afflicted with sleep apnea. What I have done with these patients is encourage them to faithfully follow a real food low-carbohydrate diet. In my experience low-carbohydrate diets work better than any other therapeutic modality to get rid of sleep apnea, and that included surgery. What’s more, it pretty much treats the sleep apnea long before much weight is lost.
I’ve had patients who have logged tens of thousands of hours on CPAP (assisted breathing) machines get off them not long after starting their low-carb diets.
If you have sleep apnea or even think you have sleep apnea, by all means see a physician. If you do have the disorder, it is extremely important to use a CPAP machine whenever you sleep, even if you simply lie down for a little nap. My very best friend died nine years ago this month because he didn’t use his CPAP when he dozed off on the couch.
My friend was probably the best, most conscientious family physician I have ever known. He took all his own call (a rarity nowadays) and went out and saw any and all of his patients who showed up in the emergency room at all hours instead of leaving them to the mercies of the on-call ER doc. He had put on some excess weight–maybe 25 pounds–and had been diagnosed with sleep apnea and prescribed a CPAP machine shortly before his death.
I visited him in his office a couple of days before he died and commented on all the pies, candy, cookies, and fruit cakes I saw scattered everywhere. He told me that all his patients brought him these as Christmas gifts. He said he couldn’t resist eating them. He also told me about his sleep apnea, which I wasn’t aware of.
I told him that he could easily rid himself of the problem and the CPAP with a low-carb diet. He agreed. He was a believer in the low-carb diet, and put as many of his own patients on as he could. He told me that he was going to start a low-carb diet right after the new year. He said he was going to go on his own version of the 12-step program to break what he believed was his carbohydrate addiction. I told him I was going to hold him to it. It was the last time we ever spoke.
He went home after a long day on December 11, played with his twin sons who had just turned nine, watched while his wife put the finishing touches on their Christmas tree. When his wife went up to put the kids down, he laid down on the couch and dozed off. when his wife came down, he wasn’t breathing. Despite all the efforts of all the best doctors in the hospital, he never regained consciousness. He was 44.
This story is to emphasize how important it is to get sleep apnea dealt with. When people with sleep apnea go to sleep, they quit breathing. Usually they wake up a little when this happens, gasp for a few breaths, snort and snore, and go back to sleep. This process is repeated throughout the night. Typically these people never get a good night’s sleep so they are tired all the next day and actually sometimes fall asleep at the wheel or while at work or an any odd time.
Occasionally, however, as happened with my friend, the low oxygen level that comes from not breathing while asleep precipitates an arrhythmia that can be fatal. That’s why the CPAP machine is absolutely essential until the sleep apnea is treated successfully.
The didgeridoo might be more fun, but I would be willing to bet that the low-carb diet is much more effective.


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  1. How amazing that so many GPs do not recognise the wider utility of many of the drugs they prescribe. The good doctor would have solved his problem by taking, before retirement, the drug Hydergine @ 4.5 mgs (usually prescribed for senility). This drug has a number of interesting benefits that are not generally known but should be. It will not cure apnoea but it sure will control the symptoms.

  2. As an apnea sufferer I read with interest your latest posting. About a year ago I read that bariatric stomach surgery affected apnea. They were not claiming cure, but that lower levels of CPAP usage were possible(?). The only improvement on CPAP usage is to not need it (CPAP) at all!
    You state pretty positively apnea can be cured by low-carb diet. Where can I find out more about this and what’s involved to affect this cure? When I looked into the claims of the bariatric surgeons I expected to find improvements were from weight loss, which seemed to be the case. This is against conventional wisdom (re:Mayo Clinic)which stated once you had it, you had it, weight loss or not. Your statments of a cure are extremely heartening!
    Thank you.
    (I am knowledgeable about low carb in general; would like more info related to apnea specifically.)

  3. A very timely entry, because my husband is scheduled for a sleep study in a few weeks to assess for suspected sleep apnea. He has an extremely narrow airway – when he had surgery last year, the anesthesiologist had to use the smallest adult-size endotracheal tube. He is at a normal weight for his height (5’10” and 170 pounds) and his physician believes there is an anatomical cause of his suspected apnea. In your experience, would a low-carb diet be effective for him? Just curious; we will of course be adhering to any treatment method his physician suggests.

  4. I am very sorry to hear about your friend. My mom was also on a CPAP machine. She got up the morning of October 15th, and after having coffee and watching the news with my Dad, he went down to his home office and she began to roll her hair. At some point between 8:45am and 9:30am she had a sudden onset cardiac arrythmia: my dad heard what was likely her last breath – a moan/groan sound. When the EMTs came, she was in Vfib, and she flat-lined twice on the way to the hospital. She had severe anoxia, and while her brainstem was functioning, it was functioning erratically. She was never conscious during the four days she was in the ICU. We took her off the ventilator and moved her to Hospice, where she passed away 11 hours later. I have been LCing off and on since 2000 – she had seen me lose over 84 lbs with LC and achieve excellent control of my Type II diabetes, yet she wouldn’t follow the LC diet herself though she supported it and believed in it. She had many many health problems (diabetes, CAD, PAD, restrictive cardiomyopathy, constrictive cardiomyopathy, foot ulcers, toxemia, impaired kidney function, etc etc etc) and I believe with all of my heart that maybe she would still be here with us if she had followed LC. The last two years of her life were fraught with one health crisis after another. I had been LCing in a “half-assed” way (sorry…) but her death has been the impetus to get me back doing what I know I need to do in order to not end up like she did. I have lost ~28 lbs since mid-October and my blood sugar is once again controlled. Thank you, Dr. Eades (both of you) for all you do to try to improve the lives of others. I just wish my mother had listened and heeded your advice. She is greatly missed.

  5. I’m sorry to hear about your mother; I’m sure she is missed terribly. I’m at least glad we both can use these awful stories as cautionary tales to warn others about the hidden potential for deadly consequences from sleep apnea. It’s good to hear that you’re back on the low-carb train.

  6. I guess you can count me among the physicians who don’t know about the utility of Hydergine, at least as a treatment for sleep apnea. I know it’s often used as a cognitive enhancement agent, but I’ve never heard of it used to treat the symptoms of sleep apnea. If you have any references, I would to see them.

  7. I would love to see references about Hydergine and sleep apnea. I am a 27 year old male and use hydergine as a nootropic. The only mention of hydergine and sleep apnea I’ve seen is at a low carb forum where some bloke was pushing it as a magical symptom-controller. Only one article comes up at PubMed when you search for hydergine apnea, so I’m a bit suspicious. Hydergine often causes congestion, and on this person’s recommendation I tried taking it at night a few times. During the day, the SE of congestion has gone away, but taking it at bedtime led to a complete inability to breathe through my nose, decreasing my sleep quality a ton.
    I’d love to believe this, but I just don’t see much evidence. Though, it does seem there would be some drug out there that could work for apnea- something that might stimulate the respiratory system but not an all around CNS stimulant…
    Hi Aaron–
    I don’t have any references about Hydergine and sleep apnea. I checked with Dr. Larry McCleary, who is up on all the brain supplements, and he had never heard of it being so used.
    Sorry I can’t help you.
    Cheers–
    MRE

  8. Have you heard of any other drugs being used for apnea treatment? Specifically, I wonder about how effective increasing base levels of catecholamines would be, perhaps via selegiline or something similar. I’m a very active and obese male, weight train 4-6 days a week and also do cardio most of those days. I’ve found a strong correlation between exercise- especially weight training, cardio alone doesn’t have the same effect for me- and snoring, apnea episodes, and sleep quality. I had been doing regular cardio 50 mins 3x/week for 3 years but didn’t see much of an overall increase in health until I added weight training to the mix.
    After a few weeks I began to see positive many changes in snoring and subjective sleep quality. Between my hacked together snoring/apnea monitoring system (computational analysis of standardized recordings of my sleep period), my subjective improvements and comments by my wife feel comfortably my budding apnea was nipped. However, if I go perhaps 10-14 days without any real exercise, my condition comes back, sleep quality goes down, snoring up, etc. This was demonstrated to me again over the last two weeks during the holidays, over which I didn’t indulge in other apnea-encouraging activities but was out of town and missing my usual workouts.
    The connection to the MAOI-B is that a daily exercise program causes an increase of the levels many of the same neurotransmitters that something like selegiline does. Though, if there was such a connection outside of my personal experience, perhaps the better prescription than a drug would be such regular exercise. 🙂
    Just a goofball idea. I should actually do some research, I can’t imagine someone hasn’t run into this before and is investigating it.
    Anyway, thanks for your previous reply!
    Regards,
    Aaron
    Hi Aaron–
    The best treatment I’ve seen for sleep apnea is a low-carb diet. I’ve had patients who had logged tens of thousands of hours on CPAP machines get totally off of them and be aysmptomatic after just a few weeks of low-carbing. I’ve never seen anyone get worse. Sleep apnea is a part of the insulin resistance syndrome. A low-carb diet improves insulin sensitivity and, therefore, improves sleep apnea, even before any significant amounts of weight are lost.
    Exercise, especially resistance exercise, improves insulin sensitivity as well. Consequently, it shouldn’t be a surprise that resistance training improves sleep apnea.
    Cheers–
    MRE

  9. Question: Day 202 of using nasal CPAP with great results (2.5 hrs during sleep study made me a believer, felt better than I have in yrs). I thought I had return of asthma/allergies/vasomotor rhinitis until 4/07 visit to new doc showed my usual BP of 85-95/70 was now 200+/!!! Last time I checked (10/05) it was usual low #s and i was recovering from pneumonia. So I’m on 1/2 Maxzide (25 mgm) with breakfast and 50 mg Cozaar (half w lunch, half w dinner) with sodium under 1800 mgs/day (I get pu,onary edema now, used to eat a ton of salt wo edema) — they wash the potassium out so I hafta eat dried apricots-bananas-oranges-potato skins (waay too many carbs) BUT they keep my BP at 140/58-64. I hate taking drugs as they affect my brain (I use a similar but wrong word all the time) & my short-term memory (I’m a tech writer wking with artififical intelligence systems, gotta be sharp & quick). I’m 59, female, obese, lucky i can do 10 mins on exercise bike the last bits of apnea zap my energy & incentive. I’d love to drop those potassium-laden fruits — where else can I get extra potassium, (someone recommended dandelion tea but I’m skeptical)? If it’s true that the high BP is from the reversal of potassium & magnesium inside the cell and calcium and sodium outside, which impairs the sodium-potassium pump & affects insulin’s ability to drive fuel into cells, due to low magnesium — what can I do to change this? I’m already taking 600 mg/day mag citrate in divided doses. I lose wt when I get carbs under 80 gm/day and I can’t seem to get there eating the fruit & potatoes. I’m down 5% of body wt, but so slow (AM temps 97-97.8. TSH 1.something with normal free T4 and T3, they didn;t measure reverse T$ whichhad been pretty high suggesting a conversion prob that led to taking Cytomel in ’01 where I overdosed trying to find right dose — BP went to 200/70 for at least 4-5 days which is the only reason he new doc didn’t hospitalize me when I showed up last April with malignant hypertension. The first day on the diuretic made me think I was dieing the side effects were so bad he dropped dose to half and I started eating dried apricots. I lost 7.5 #s then no more). My fasting sugars were 120 & 126 but after 30 mins driving on interstate w horrific amts of traffic so I don’t trust them as fasting, more likely ‘after stress’ level. Too, high AM glucose levels are common with apnea. My SO2 went down to 87, not terrible but not good either; when I get BP cked it’s usually mid-high 90s now. I use a Hearthmath emWave trainer to reduce stress. I mostly (95%) sleep 7-9 hrs/night. Reading about the benefits of resistance trng means I start using my strechy bands again. Cardiologist & pulmonologist say for some it can take 8-12 months for the “biochemical stew” to normalize after starting CPAP *sigh*. It’s disheartening to see so little change when my life has been tuned upside down. Any suggestions? Glyglosylated hemoglobin was 7 last April.
    I can’t possibly jump in with so much going on and try to manage your care over the internet. I can tell you that potassium can be had in supplement form (I give my own patients Micro K 10 mEq caps, and have them take one per day), which means you could give up the fruit that contains a little potassium and a whole lot of carbohydrate. Any thing you can do to reduce carb intake should improve your sleep apnea.

  10. Thanks for the comments Doc! I’m better: sense of humor returning & mood is better & so is attitude (others have commented on how much better I look and act), much more rested & able to exercise more, overall carb intake is down even tho eating 5-6 dried apricots at dinner along with half a Red Copper orange-ruby red grapefruit hybrid he’s developed (6% potassiumn they claim), losing slowly but hey I’m eating apricots & that grapefruit *grin*, fewer low potassium episodes, finally waking rested most days, last month added a 500 mg proline/500 mg lysine combo and active D3 to supplements (probably have most expensive pee in the SE *grin*, drink 2 ozs POM juice @ bfast as it’s been shown to reduce systolic pressure, cognitive effects reduced as long I keep drugs several hrs apart (transient ‘low’ BP my cardiologist theorizes). BP running 126/60s-mid70s at same drug dosage; tried halving Cozaar but systolic went up as did pulmonary edema (oh well, too soon, try again after more wt disappears). Cardiologist is happy w my progress (thinks I’ll have compete reversal of all this ‘stuff’ when I finally get the wt off); will do another echocardiogram in 6 mos. to ck lung pressure. See the pulmonologist for apnea followup in a few wks. Then, back to internist — bet he’ll be a vampire demanding tons of blood for workups — needed as I began this medical adventure a yr ago today. Lesson learned this spring: apnea masks and allergy congestion are not friends! Still, life is looking pretty durned good these days *G*! 1777 hrs logged on nCPAP; I still wish fervently for the day when I can stop using this oh-so-needed-right-now gadget.
    Keep after it, and you should be able to get off the CPAP at some point. I’ve had a number of patients who had logged more hours than you who were successful.

  11. Found my potassium source: low-sodium V8; for 10 carbs, I get 140mg sodium (OK sodium, I plan 400/meal), and 570 mg potassium! It’s sorta natural *G* and it’s got celery which has some 20 gazillion-letter chemical (that I can’t remember) that lowers BP, which means I can eat celery again (great snack & in salads, love it steamed) which I’ve eaten little of as it’s got quite a but of sodium. No more eye twitches, no more leg tingling & heaviness…YEAH!!! Might be able to make a salad dressing out of this, too, with some olive oil, more parley, basil, thyme/rosemary….. Now I can drop all high carb fruits ‘cept the POM juice — this oughta help with the wt loss.
    My energy level is now high enough I’m getting on my exercise bike several times/wk; might be only 10 mins at ta time, but that’s 10 mins I couldn’t do a month ago.
    PS Still not sure that playing a digeridoo really helped the apena, what else in the study patients lives night have changed that led to the improvements? Tho “they” claim humming helps chronic sinusitis, and singing helds asthma…maybe it’s the music vibration that affects the brain, or reduced stress/more pleasure.

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